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Welcome to our blog page! Here, you’ll find a collection of blogs written by our Synergy experts on a wide range of topics related to lien resolution, government benefit preservation, Workers Compensation, and more. While these blogs may not fit neatly into a specific category, they contain valuable information and InSights that we believe will be of interest to our clients and readers. Our team is committed to staying up-to-date on the latest developments and trends in the industry, and we’re excited to share our knowledge and expertise with you. Check back often for new blog posts and updates on a variety of topics!
In a personal injury law firm, time truly is money. The longer a case remains on your desk, the longer your clients wait for their recovery and your firm’s revenue realization is delayed. This is where the concept of Time on Desk becomes crucial—the period from when a client hires your firm to the final disbursement of their recovery.
Why Does Time on Desk Matter?
Optimizing Time on Desk is one of the most impactful strategies to enhance profitability without increasing your caseload. By focusing on Time on Desk and strategically outsourcing tasks like lien resolution, you can streamline operations, reduce delays, and significantly boost your firm’s efficiency and bottom line.
The key is efficiency. By reducing delays, particularly in the resolution-to-disbursement phase, you can accelerate cash flow, improve client satisfaction, and increase revenue. For example, shaving 30 days off your timeline could mean doing 13 months of work in just 12. One place to do this is during the resolution-to-disbursement phase.
Solving the Lien Resolution Bottleneck – Accelerating Disbursement
A major bottleneck during that phase often occurs during the lien resolution process. Lien resolution is often a tedious, time-intensive process that creates significant bottlenecks. Hours are spent managing paperwork, chasing medical records, and negotiating with lien holders—tasks that frequently prolong case closure and delay disbursement. These inefficiencies not only slow your firm’s cash flow but also hinder your ability to move on to new cases, impacting overall productivity.
By outsourcing lien resolution, you can delegate this critical yet labor-intensive task to experts who specialize in handling it efficiently. This allows your team to focus on high-value activities, focusing on what they do best. Outsourcing accelerates case resolution timelines, increases throughput, and ultimately improves your firm’s profitability and operational flow.
Power of Outsourcing
When you outsource lien resolution, you’re not just saving time – you’re also ensuring that your team’s efforts are focused on their highest-value tasks. Tasks like increasing the value of existing cases, bringing in new clients and building your practice. Outsourcing lien resolution gives you seasoned experts who can work on your behalf, ensuring that your client’s funds get disbursed promptly. Meanwhile, your in-house team can continue to move cases forward, maximizing efficiency across the board.
By outsourcing these non-core administrative activities, you streamline your operations, reduce overhead, and ultimately increase profitability. Your firm can handle more cases in less time, leading to better/faster resolution of inventory and higher revenue. It is part of a holistic plan to cut down Time on Desk.
Conclusion
The Time on Desk metric measures how efficiently your firm turns cases into revenue. By minimizing delays and leveraging outsourcing, you can accelerate case timelines, boost profitability, and enhance client satisfaction.
As this year comes to an end, consider: Are you effectively reducing Time on Desk? Do unresolved liens have files stalled on your desk? And most importantly, do you have a clear strategy to streamline Phase 3—settlement to disbursement—for 2025? If you need help answering these questions in the right way for your firm, consider partnering with Synergy to improve Time on Desk. Contact Synergy today.
Written by: Jason D. Lazarus, J.D., LL.M., MSCC | Chairman of the Board
Resolving liens effectively is critical in protecting your client’s net recovery when settling personal injury cases. Lien identification, verification, and audit are critical steps in ensuring that all potential claims are addressed and safeguarding your client’s net settlement. Here’s how to tackle these crucial processes.
Lien Identification Process
It all stars with the initial case assessment at intake. Start by gathering detailed information about healthcare providers, insurers, and other potential lienholders, including government programs (Medicare, Medicaid), private health insurance, and workers’ compensation. Collect and review all medical documentation to identify entities that may assert a lien.
Next, post intake you should obtain copies of health insurance policies and any insurance company correspondence to understand coverage and subrogation claims. Request itemized statements from healthcare providers to identify potential lien charges. Use the Medicare Secondary Payer Recovery Portal (MSPRP) and state Medicaid offices to identify any liens being asserted by government benefit programs. Verify potential liens with private insurers using Explanation of Benefits (EOB) statements. Identify any liens from ERISA plans, FEHBA plans, military healthcare providers, and workers’ compensation carriers.
Lien Verification Process
Start with confirming potential lienholder claims. Contact all potential lienholders to confirm lien existence and amounts. Obtain formal lien documentation, including detailed billing statements and legal notices. Match lienholder claims with client medical records to verify accuracy. Review insurance policy provisions or plan documents to confirm lienholder rights to recovery.
Lien Audit
Once you have completed the verification process, next up is auditing claims made by lienholders. Best practices are to organize all gathered information into a comprehensive lien spreadsheet or database. Establish criteria for the audit, such as accuracy of claimed amounts, compliance with legal requirements, relatedness and consistency with the client’s injuries.
In performing the audit, identify discrepancies or unsupported claims. Ensure all claims adhere to state and federal laws, including notification and filing requirements. Address any discrepancies with lienholders, providing supporting evidence.
Documentation/Record-Keeping & Client Communication
As part of your resolution process, you should have a policy on maintaining Records. Keep a detailed lien log and archive all correspondence with lienholders. Regularly update clients on lien status and any negotiations or disputes.
Conclusion
Implementing effective processes for lien identification, verification, and audit is essential for ensuring good lien resolution practice. A structured approach reduces the risk of future claims, enhances client satisfaction, and protects your firm from potential costly mistakes.
For a more detailed guide on a comprehensive process download our white paper titled “Comprehensive Processes for Managing Lien Resolution: Identification, Verification, and Audit” by clicking HERE. If you are ready to work with an expert lien partner, contact Synergy today for a CONSULTATION about outsourcing lien resolution.
Written by: Jason D. Lazarus, J.D., LL.M., MSCC | CEO
In personal injury law, attorneys focus on proving causation, liability, and damages. Given the complexities that arise during settlement, outsourcing certain tasks has become a common practice to enhance efficiency and client outcomes. Just as attorneys engage experts in probate, guardianship, tax matters or even medical record retrieval, lien resolution can similarly benefit from specialized assistance. This approach not only addresses the complications of lien resolution but also when done correctly complies with ethical requirements and improves client outcomes.
Why Outsource Lien Resolution?
Personal injury attorneys often face multifaceted lien issues that are governed by intricate laws and regulations, such as ERISA, the Medicare Secondary Payer Act, and various state-specific laws. For instance, a client may have multiple Medicare components—Traditional Medicare (Parts A/B) and Medicare Advantage (Part C)—each with distinct obligations and requirements. Navigating these can be overwhelming, especially when dealing with several different lien types in one case.
Ethical Considerations
Outsourcing lien resolution is both practical and ethical, provided it is managed correctly. ABA Formal Ethics Opinion 08-451 outlines that while lawyers can outsource legal and non-legal support services, they must retain ultimate responsibility for the work and maintain direct supervisory authority. This means that while lien resolution experts can handle the details, the attorney oversees their work and ensures compliance with all professional obligations.
State-Specific Guidelines
Different states have addressed the outsourcing of lien resolution. For example, New York permits lawyers to hire external lien resolution firms as long as the costs are reasonable, disclosed to the client, and result in a net benefit. Similarly, Ohio and Utah have established that outsourcing is permissible under certain conditions, including obtaining client consent and ensuring the fees are reasonable and transparent.
Key Takeaways
- Efficiency and Expertise: Outsourcing lien resolution can streamline the process, reduce operational costs, and leverage the expertise of specialists to enhance client outcomes.
- Ethical Compliance: Ensure that the outsourcing process adheres to ABA Model Rules and state-specific guidelines, including maintaining client confidentiality, securing informed consent, and ensuring costs are reasonable.
- Client Benefit: The primary goal of outsourcing should be to protect and maximize the client’s recovery. This approach helps ensure that lien resolution is handled expertly, safeguarding against potential legal and financial risks.
In conclusion, outsourcing lien resolution is a strategic decision that, when done ethically, helps a law firm run more efficiently and benefits clients by securing better outcomes. If you want to do a deep dive into ethical outsourcing of lien resolution, click HERE to download our white paper called “How to Outsource Lien Resolution Ethically”. If you are ready to outsource today and partner with Synergy, contact us TODAY.
Written by: Jason D. Lazarus, J.D., LL.M., MSCC | CEO
Introduction
In the world of personal injury law practice, balancing profitability with exceptional operational efficiency poses a significant challenge. You want to deliver world-class customer experience while getting the balance right with running your firm efficiently as well as profitably. To navigate this challenge, law firms can utilize the Entrepreneurial Operating System (EOS) Traction model in combination with outsourcing. This dynamic combined approach helps streamline operations, boost efficiency and ultimately drive profitability. This blog discusses, at a high level, how personal injury law firms can incorporate these strategies to achieve outcomes.
Understanding the Fundamentals of the EOS Traction Model
The EOS Traction model, crafted by Gino Wickman offers a framework for managing and optimizing businesses. While some may feel a law practice is different, the Traction model works with any business enterprise. It revolves around six core elements:
- Vision: Establishing a shared vision for the firm to align all team members toward objectives that need to be achieved. Think of something like the mission to help injured parties recover just compensation!
- People: Ensuring that individuals are in roles to maximize productivity and job satisfaction. Making sure the right people are in the right seats within your firm to deliver on your vision.
- Data: Utilizing metrics and data to inform decision making processes and monitor performance. Looking at critical KPIs within your business (law practice) to ensure you are achieving what you have set out to do.
- Issues: Promptly identifying and resolving issues to uphold operations. Every business, and your law firm, is no different, has operational issues that need to be solved so this process is an incredibly important one.
- Process: Documenting and refining fundamental processes to guarantee consistency and efficiency. The key to consistency and longevity, as well as scale, is documented processes. Especially important for firms in growth mode or looking to grow.
- Traction: Enforcing disciplined execution and accountability to reach the firm’s goals.
By embracing the EOS Traction model, personal injury law firms can establish a foundation to drive continuous growth and profitability. While it may not be as straightforward as it seems at first glance there’s no need to worry because numerous EOS experts, with knowledge of law firm operations, can play a pivotal role in implementing EOS within your practice.
Incorporating Strategic Outsourcing
While the EOS Traction model offers a structure for efficiency, strategic outsourcing complements it by taking specific tasks off your team’s place and giving to an external team that are specialists. Outsourcing enables law firms to concentrate on their core strengths while tapping into know-how for functions that can be handled more effectively by experts. Key potential areas for outsourcing tasks many personal injury law firms do inhouse today include:
Lien Resolution
- Expertise and Efficiency: Outsourcing lien resolution to specialized firms ensures compliance with complex regulations and maximizes lien reductions, allowing the firm to focus on client advocacy. It removes the burden of administrative work from a law firm’s staff, creating more efficiency and profitability for the law firm.
- Risk Mitigation: Specialized lien resolution groups stay updated on legal developments, reducing the risk of errors and compliance issues when outsourced to an experienced lien resolution company.
Medical Records Review
- Detailed Analysis: Outsourcing the review of medical records to experts ensures thorough and accurate documentation, supporting stronger outcomes.
- Time Savings: External reviewers can handle large volumes of records quickly, freeing up internal resources for other critical tasks.
Marketing and Lead Generation
- Targeted Campaigns: Professional marketing firms can design and execute targeted campaigns to attract potential clients, increasing the firm’s caseload and revenue.
- Analytics and Optimization: Marketing experts provide insights and analytics to optimize campaigns, ensuring the best return on investment.
Maximizing Profitability through EOS Traction and Outsourcing Integration
When integrated, the EOS Traction model and strategic outsourcing create a powerful synergy that drives efficiency and profitability in personal injury law firms. Here’s how:
- Core Competency Focus
By outsourcing specialized tasks, law firms can focus on their core competencies, such as client representation and legal strategy, ensuring higher quality service and better case outcomes.
- Scalability and Adaptability
Outsourcing provides scalability, allowing firms to handle increasing caseloads without the need for significant internal resource additions. This flexibility supports growth and profitability.
- Data Driven Decision Making
The EOS Traction model emphasizes data-driven decision-making. By developing key metrics for operations, firms gain access to advanced analytics and insights, informing strategic decisions and optimizing performance.
- Optimizing Operations
By documenting and fine-tuning procedures using the EOS framework, operations can be streamlined. This helps to minimize inefficiencies, reduce expenses and boost productivity.
- Enhanced Client Satisfaction
Efficient operations lead to faster resolution of cases and improved client outcomes. This in turn results in higher client satisfaction and positive testimonials/Google reviews, which are crucial for the firm’s continued growth.
Conclusion
Combining the EOS Traction model with strategic outsourcing offers personal injury law firms a comprehensive approach to achieving operational excellence and profitability. By focusing on core competencies, leveraging external expertise, and implementing disciplined execution and accountability, firms can navigate the complexities of personal injury law firm practice with greater success. This approach not only enhances profitability but also ensures sustained growth and client satisfaction, positioning the firm for long-term success in a competitive market.
If you want to learn more about outsourcing lien resolution to Synergy, go to www.partnerwithsynergy.com
To learn more about the Traction/EOS model go to www.eosworldwide.com
April 11, 2024
Childs v. Commissioner, 103 T.C. 634 (1994), forms the legal basis for attorney fee deferral and outlined several benefits for attorneys who defer legal fees. The case involved an attorney who had deferred a portion of his contingency fees from representing clients in personal injury cases. The IRS challenged the attorney’s deferral arrangement, but ultimately the Tax Court ruled in favor of the attorney.
Over the past twenty years, the marketplace has expanded greatly. According to the Insurance Information Institute, in 2020, the total losses for liability insurance reached $202.9 billion (inclusive of personal injury, medical malpractice and wrongful death claims). Similarly, the fee deferral programs available have increased and now attorneys have a wide variety of options and investments available. However, the total amount of dollars that have been deferred by attorneys has stayed stagnant.
Why more attorneys defer taxation of their contingent legal fees? Great question when you look at the benefits of doing deferral. But there are important considerations and issues to make sure it is the right choice for a specific fee:
The benefits:
Tax Deferral: By deferring the receipt of income, one can potentially defer taxation in the current year, lower the overall payment of tax and have their fee grow tax-deferred until received.
Income Averaging: This can help attorneys manage their income and tax liability by spreading payments into more equal annual income to reduce the amount taxed at higher rates. It also allows the firm (business) to plan revenue out with more certainty.
Investment Opportunities: The investment options in a deferral program allow all the dollars to potentially earn interest or capital gains without taxation while they are held in the program.
Asset Protection: Depending on the structure of the deferral agreement, the deferred legal fee may be protected from creditors and other claims.
Retirement Planning: Most of the programs do not have deferral caps and integrate well with other traditional retirement planning strategies.
No lImit (amount or age): The benefits are like most retirement plans but do have the added advantage of no cap on the amount you can defer in a single year and allowable withdrawals prior to age 59.5. These are extremely valuable when used in conjunction with other retirement planning programs.
The downside:
Financial Constraints: Attorneys and firms often utilize their personal finances to fund their law firm’s investment in cases. They may prioritize paying down debt or saving for future cases.
Lack of Awareness: The programs available are not widely known in the Tax Attorney, CPA, or Financial Planner markets. These groups are who attorneys typically go to for guidance and advice in their planning. The programs are specific to attorneys working on contingency fees and unique to this profession.
Short-term Thinking: There is always a battle between using funds now and receiving instant gratification versus savings for the long term.
Fear and Uncertainty: Trial lawyers have income that varies from year to year, sometimes with huge swings up and down. This variance often creates a fear of not being able to access the funds in case of an emergency. In addition, many professionals fear the uncertainty of the economic environment and the performance of markets.
Access Limitation: The programs available have limits on the ability to access funds. You typically cannot increase the amount or frequency of the withdrawal schedule for immediate access.
Time: The programs available require decisions and documentation that is more complex than most retirement plans and becomes part of the settlement documentation. It may take a prospective attorney longer to understand and seek advice from their advisors. Typical plans need to be implemented and set in motion prior to a case coming to a resolution.
Conclusion
Like most retirement plans, attorney fee deferral programs have benefits and risks associated with implementation. If the program is used with other retirement plans, you can overcome many of the obstacles listed above. The benefits of deferring legal fees will vary based on the individual circumstances of the attorney and the terms of the program they utilize. Attorneys should consult with tax and financial professionals to review their specific situation and develop strategies that work best for their wants and needs. Attorney fee deferral programs do not work for everyone but should be considered as part of your overall financial strategy. See here how Synergy can assist today.
October 12, 2023
Rasa Fumagalli, JD, MSCC, CMSP-F
The Differences Between an MCP & LMSA
A Medical Cost Projection (“MCP”) report helps a personal injury attorney quantify an injury victim’s future medical expenses. The report is generally prepared by a nurse allocator and will include projections for treatment that might occur as a result of the initial injuries. For example, an individual who has undergone a spinal fusion has a 36% chance of developing adjacent segment degeneration within 10 years after their initial fusion surgery.[1] In light of this, the MCP report is likely to include projections for spinal fusion extension surgeries and the associated care. Although there is a degree of uncertainty when it comes to predicting the course of an injury victim’s future care, the personal injury attorney can rely on the MCP in seeking to demand that his/her client receives sufficient compensation to cover any possible future injury-related care and medical bills.
A Liability Medicare Set-Aside (“LMSA”), on the other hand, is a settlement tool whereby a portion of an injury victim’s net settlement is earmarked for future injury-related Medicare covered treatment. Once the portion that is “set-aside” is properly spent on such post-settlement injury-related care, Medicare will step in and become the primary payer for any additional injury-related services.
So how do you reconcile the future medical projections in an MCP with a desire to limit the size of the LMSA? We begin the analysis with an overview of the MSP compliance framework. The MSP Act and regulations prohibit Medicare from making payment for services to the extent that “payment has been made or can reasonably be expected to be made under a workmen’s compensation law or plan of the United States or a State or under an automobile or liability insurance policy or plan (Including a self-insured plan) or under no-fault insurance.”[2] A primary payer’s reimbursement obligation to Medicare may be demonstrated by “a judgment, a payment conditioned upon the recipient’s compromise, waiver or release (whether or not there is a determination or admission of liability) of payment for items included in a claim against the primary payer or by other means.”[3] Section 111’s Mandatory Insurer Reporting requirement ensures that Medicare is placed on notice of the settlement and injuries alleged in the underlying matter. The reporting is intended to help Medicare recover conditional payments and avoid making improper future payments.
While parties must address Medicare’s conditional payments in connection with a settlement, there is less clarity when it comes to the best way to consider Medicare’s future interests in a liability settlement. A failure to consider the interest may result in Medicare’s denial of post-settlement injury-related treatment that was claimed as a part of the personal injury case. Depending upon the settlement amount, an injury victim may elect to remove this risk by setting aside some of the settlement funds in an LMSA.
Although the MCP report and LMSA both deal with the projection of future injury-related care, they each address this issue in different ways. They are two sides of the same coin. The MCP will always be higher than an LMSA since the MCP projections reflect future treatment that may possibly occur, while the MSA reflects future injury-related treatment that is reasonably likely to occur. For example, in the situation where an injury victim might develop adjacent segment degeneration after fusion surgery, an MCP may include spinal extension surgery, while an LMSA would not. Another difference is that the MCP report includes projections of services that are not covered by Medicare, while an LMSA only includes Medicare covered services. Examples of non-Medicare covered injury-related services that you may find in an MCP include long-term custodial care, massage therapy, and transportation expenses. Since these injury-related services are not covered by Medicare, they would not be included in an MSA.
The life expectancy used in an MCP may also vary from the life expectancy in an MSA. The MCP may use an individual’s standard life expectancy without any consideration of co-morbid conditions. The LMSA however will usually be based on a rated age that factors in an individual’s co-morbidities in assessing their life expectancy. Current Procedural Terminology (CPT) codes also impact the pricing of the treatment projections. While an MCP projection may use the most comprehensive CPT code for a service, the LMSA projection will use one that is more limited in scope. While both the MCP and LMSA price the CPT codes for the services based on the usual and customary charges for the area where the injury victim resides, the MCP will often use a higher reimbursement rate than the LMSA in the projections.
In addition to the above differences between the MCP and the LMSA, the goal of each report is different. An MCP is used to demand 100% of the future injury-related medical damages in a case, while an LMSA will look at the parameters of the settlement in determining an appropriate amount to “set-aside” for future injury-related Medicare covered treatment. Unlike a workers’ compensation settlement where the workers’ compensation insurance carrier may fully fund all the future injury-related medical in an accepted case, a liability settlement is usually a compromise with a limited recovery on a greater range of damages. In light of this, it is reasonable to consider the relative value of the total damages suffered and the injury victim’s net settlement when assessing the amount of the LMSA that should be carved out from the settlement.
There are several ways to address Medicare’s future interests in a settlement and any given approach will depend on the facts of the case and the injury victim’s risk tolerance. Although an LMSA may be appropriate at times, there are other situations where a set-aside is uncalled for. This may occur when an injury victim’s treatment has concluded, and he is able to obtain a written treating physician certification that all injury-related treatment has concluded and no further injury-related care is indicated. Charlotte Benson’s September 20, 2011, Medicare memo specifically states that when a treating physician makes such a certification, Medicare considers its interest, with respect to future medicals, for that particular settlement satisfied. Similarly, a set-aside may be uncalled for when a settlement with significant objective economic damages is limited by inadequate policy limits. This settlement may be viewed as one that is insufficient to fund any future injury-related medical care. The support for this position comes from CMS’ May 25, 2011 Stalcup memo which provides that “Each attorney is going to have to decide, based on the specific facts of each of their cases, whether or not there is funding for future medicals and if so, a need to protect the Trust Funds.”
Conclusion
Both MCP reports and LMSAs have their place in the resolution of a liability settlement. MCPs bring value to any personal injury matter regardless of the injury victim’s Medicare status. By quantifying the future injury-related medical in a case, the personal injury attorney is able to provide support for the initial demand or use the MCP report to bridge the gap between the settlement offer and the settlement demand. When a settlement involves a Medicare beneficiary, it is important for the personal injury attorney to make sure that the injury victim is advised of the potential impact of the MSP Act on the settlement and that proper documentation is obtained for the attorney’s files.
Synergy Settlement Services is here to help you with both MCPs and Medicare Secondary Payer consulting. Our team of experts can provide expert support whether it is quantification of future damages or compliance with the MSP. Find out more here.
[1] https://regenerativespineandjoint.com/2023/06/27/adjacent-segment-degeneration-after-spine-fusion-surgery/#:~:text=One%20study%20found%20that%20the,initial%20fusion%20surgery%20(2)
[2] 42 U.S.C.§1395 Y(b)(2)(a).
[3] 42 C.F.R.§411.22.
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